Cell Therapy for Nonischemic Dilated Cardiomyopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Cell therapy involves transplantation of human cells to promote repair of diseased or injured tissues and/or cells. Only a limited number of mostly small-scale trials have studied cell therapy in nonischemic cardiomyopathy (NICM). We performed a metaanalysis of randomized clinical trials (RCTs) to assess the safety and efficacy of cell therapy in NICM. Electronic databases were searched for relevant RCTs from inception until August 2020. Outcomes assessed were left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter or volume (LVEDD), quality of life (QoL) indices, and major adverse cardiac events (MACEs). Weighted mean differences (MDs) and standardized mean differences (SMDs) were calculated using randomeffects methods. Eleven RCTs with 574 participants were included in the analysis.There was a significant increase in mean LVEF (MD, 4.17%; 95% confidence interval [CI] = 1.66-6.69) and modest decrease in LVEDD (SMD, À0.50; 95% CI = À0.95 to À0.06) in patients treated with cell therapy compared with controls. Cell therapy was also associated with improvement in functional capacity, as assessed by the 6-minute walking distance (MD, 72.49 m; 95% CI = 3.44-141.53). No significant differences were seen in MACEs and QoL indices between treated and control groups. This meta-analysis suggests that cell therapy may improve LV systolic function and may be associated with improvement in LVEDD and functional capacity compared with maximal medical therapy. Cell therapy was safe, with no significant difference in MACEs between treatment and control groups. However, given the limitations of Avnish Tripathi and Mohammad Saud Khan contributed equally to this study.

Bioinformatics analysis and identification of potential key genes and pathways in the pathogenesis of nonischemic cardiomyopathy

“…[3,15,16] The morbidity and mortality of NICM remains high despite the availability of new therapeutic approaches, such as heart transplantation and cell therapy. [6,8] Bioinformatics analysis provides useful information and assistance to identify the role of relevant genes, proteins, and signaling pathways in the development of disease. [17,18] In this study, 36 co-expressed DEGs were identified in 2 datasets (GSE1869 and GSE9128).…”

“…[3][4][5] Nonischemic cardiomyopathy (NICM) is a primary reason for advanced heart failure, which accounts for more than half of all heart transplants. [6,7] Despite considerable improvements in the management of NICM, which can dramatically prolong patient survival and relieve patients' symptoms, [8] the mortality related to NICM remains a serious medical problem. [9,10] Thus, it is necessary to find new critical targets to diagnose NICM early and improve the prognosis of the disease.…”

Mass Customized Outlook for Regenerative Heart Failure Care

“…Pre-clinical work, as of today, has led to 793 registered clinical trials categorized under the keywords of “heart” and “cell therapy” at the U.S. National Library of Medicine database, ClinicalTrials.gov. This experience, based on over 1700 pre-clinical and clinical trials, has collectively enabled increasing levels of evidence with reassuring feasibility and safety for adult stem cell use [ 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. Indicators of benefit, however, have remained inconsistent among treated patients [ 44 , 45 ].…”